Pegylated G-CSF
Pegfilgrastim
Brand names: Neulasta, Pelmeg, Ziextenzo, Pelgraz
Adult dose
Dose: 6mg SC single dose ≥24 hours after chemotherapy and ≥14 days before next cycle
Route: Subcutaneous
Frequency: Once per chemotherapy cycle
Clinical pearls
- Primary prophylaxis when febrile neutropenia risk ≥20%; secondary prophylaxis after first neutropenic episode (ESMO/NCCN)
- NICE/SACT-funded for adjuvant chemo regimens
- Multiple biosimilars cost-effective and routinely substituted
Contraindications
- Hypersensitivity to filgrastim/pegfilgrastim or E. coli-derived proteins
Side effects
- Bone pain (very common)
- Splenomegaly / splenic rupture (rare)
- Acute respiratory distress syndrome
- Capillary leak syndrome
- Sickle cell crisis (caution in SCD)
- Glomerulonephritis
- Aortitis (rare class effect)
Interactions
- Lithium (theoretical neutrophilia)
Monitoring
- FBC
- Symptoms of bone pain (paracetamol/loratadine commonly used prophylactically)
- Splenic enlargement
- Renal function
Reference: BNF; ESMO febrile neutropenia guidelines; NICE/SACT protocols; SmPC; https://bnf.nice.org.uk/drugs/pegfilgrastim/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Pathways
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO